The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored by the Ministry of Health (MoH), WHO and partners. Significant improvements have been made over the past weeks, including strong performances by field teams conducting vaccinations and improved community engagement and risk communication in priority areas. However, as new cases continue to emerge from both Beni and near Kasenyi, which is in a security ‘red zone’ and close to internally displaced person (IDP) camps, it is clear that risks remain and that strong response measures need to be maintained. This is largely due to security conditions that severely impact both civilians and frontline workers, at times forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. There is evidence of ongoing transmission within communities, particularly in Beni. For more than half of new cases, investigations are ongoing to establish epidemiological links. Neighbouring countries continue to receive support to improve their readiness capacities for potential threats of EVD.

Additional resources are necessary to both expand the response in the Democratic Republic of the Congo and increase preparedness in border nations. The MoH, WHO and partners continue to rapidly adapt to these challenging circumstances, with over 250 staff on the ground scaling up all pillars of the response – surveillance, contact tracing, community engagement, lab testing, infection prevention and control, safe and dignified burials, vaccination, and therapeutics.

Since WHO’s last situation report on 9 October 2018 (External Situation Report 10), an additional 35 new confirmed EVD cases and 24 new deaths have been reported. As of 15 October 2018, a total of 216 confirmed and probable EVD cases, including 139 deaths, have been reported, resulting in a global case fatality ratio (CFR) of 64% (Table 1). Among the 216 cases, 181 are confirmed and 35 are probable. Among the 139 deaths, 104 are among confirmed cases and 35 among probable cases. The CFR among confirmed cases was 57% (104/181). On 15 October, a total of 32 new suspected cases are under investigation in Beni (21), Mabalako (6), Butembo (3), Tchomia (1) and Mandima (1).

As of 15 October 2018, 57 cases have recovered, been discharged from ETCs, and re-integrated into their communities. A total of 43 cases (20 confirmed and 23 suspected) remain hospitalized in the ETCs. The treatment centres in Beni and Butembo recorded an occupancy rate of 76% (31/41) and 42% (10/24) respectively. Among the 207 cases with known age and sex, 54% (n=111) are female and adults aged 15-44 account for 60% (n=124). Recent cases in Beni include a disproportional number of cases in children aged ≤16 years; 47% (n=20) of 43 total cases reported since 1 October 2018, including 9 cases in infants and young children aged <5 years. Investigation teams are intensively reviewing potential sources of the recent increase in cases among children.

To date, the total number of health workers affected in this outbreak is 20, including 19 confirmed. Three health workers have died from the disease. One case confirmed on 7 October 2018 is a MONUSCO civilian staffer working in Beni, who is currently hospitalized at the Beni ETC.

The confirmed cases were reported from six health zones in North Kivu Province: Beni (77), Mabalako (71), Butembo (13), Masereka (4), Kalunguta (2), and Oicha (2); and three health zones in Ituri Province: Mandima (9), Tchomia (2) and Komanda (1). The epicentres of the outbreak remain Beni and Mabalako Health Zones in North Kivu Province, reporting 39% (n=85) and 43% (n=92) of all confirmed and probable cases respectively. Beni, Butembo, Masereka and Mabalako continue to report an increasing number of new cases, indicating the persistence of Ebola virus transmission in these areas. The Beni Health Zone has reported 71% of all cases reported since September 2018. Of the total deaths reported to date, 48% (n=67) were from Mabalako, while 40% (n=55) were from Beni.

The Ministries of Health (MoH), WHO and partners are monitoring and investigating all alerts in affected areas, in other provinces in the Democratic Republic of the Congo and in neighbouring countries. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in The Gambia, South Sudan and Uganda. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.